AL facility is suggesting we move our relative to dementia care. We don't agree that it is necessary. Does anyone have experience with this?

Alva, We are a private pay facility - assisted and a skilled nursing unit. We have two staff physicians who rotate shifts. We are in a rural area with hospitals a fairly far drive away. My dad is a doctor and is part owner. My husband is also a doctor and part owner. My father is 100% retired. My husband is also retired but can fill in in a pinch. The two doctors we have are rural health doctors. They work and receive credit on their med school loans. They can get credit on their loans for 2-3 years. Because of the loan credits, it holds down salary.

Worried, The only state I’m aware of that uses the form is NC Medicaid. We transferred a patient to NC and the form was required. The family took the resident to a private physician for evaluation. I know the state I live in and the adjoining state do not require the form.

Our facility has our own staff doctors and they along with other members of professional staff make the decision. If the patient/client involved still maintains an outside physician, they are not involved in this type of decision at the facility.

And as previously state, the family is free to give notice and use another facility. No one is chained to our facility.

While this is a debatable question the end result is going to have to be based on what her medical team has to say. You have a few questions that need to be addressed.
Why are they saying she needs memory care!
Although capable of feeding herself, is she? My dad was capable, however, his fridge was filled with green meats, brown lettuce etc. His cereal boxes were empty and or expired.
Are they finding her wearing rhe same clothes a few days in a row?
Since family has not been to see her things could have changed dramatically in the past 5 months.
There are good and bad days, and when you call to talk to her she may be on a good day.
Have the center explain their reasons. speak with an elder care attorney and her doctors that see her regularly.

BEST wishes

More than 1 State requires it.

I am in one state, my LO is in another state. :)

When my LO, age 88, started to have needs for more care, the POA sent in and paid for caregivers.

My state does not require FL2 form. On admission the doctor recommends level of care. After that it is up to the facility. If the family does not want to go to higher level of care that’s their choice. The doctor does not enter into that decision, just the facility. The doctor is not on site to make this decision.

An FL2 form is basically a form that a doctor must fill out for a patient/resident for a care facility.

This form indicates patient/resident's diagnoses, medicines and level of care.

An FL2 form is the very first thing that a facility requests upon admittance. (where I am from)

The level of care never changes unless the doctor decides/agrees.

Here, an Administrator, Family or Guardian may "suggest" what level of care they would want for a resident but the doctor has "the final say."

No, an FL2 is not a government requirement.

I am not stating about something I know nothing about. I've experienced this not once but several times.

The Administrator of facilities have suggested a "higher level of care" for my loved one. However, they could not do a thing unless the doctor agreed and changed it himself (with signature) on the FL2 form.

Oh, by the way, OP is not stating the facility is trying to get "rid of their LO".

The OP is saying "the facility is suggesting a higher level of care."

You are right. I am aware facilities will find a way to "get rid of residents". However, I do not believe changing the "level of care" that has the doctor's signature on it is "a way."

In order for a person to go into a care facility, (AL, MC, SNF, ect.) a "doctor" must assess the person's "level of care."

A "doctor" then must feel out paperwork called an FL2 form indicating "what level of care" someone needs.

Hence, with that being said, If a resident is already in Assisted Living and the Administrator suggests a "higher level of care" to "Memory Care", the doctor must "agree."

The Administrator does not have the authority to move a resident to a "higher level of care" unless the doctors changes it on the FL2 form.

Therefore, "The doctor does have the final say."

I thought that AL places were for ones that could handle most of their own needs but would only need minor assistance, apparently she is requiring more now that they can handle and that is why the suggested the move where she can be watched better.  Ask the administrator about the change.  If she is familiar with the place it shouldn't be too much of a shock.  hoping this works out for you.

I am quite sure that no facility can promise that a resident will be able stay "as long as they live" in independent or assisted living.
If you believe that was promised, find it in writing! It should be obvious to anyone that no guarantee like that can be made...not for any resident, at any time. I think what is meant is that they will provide a certain level of care as long as needed (which, for many, could be for the remainder of life). Good sales technique.

There used to be some companies, and perhaps some still exist, that offer a "contract" for life-long care, including whatever level of care is needed from independent living through skilled nursing care. This involved a genuine legal contract and required a substantial financial investment up front, much more than the average facility requires (or that an average family can afford)

You can bad-mouth facilities as much as you please. And some, without doubt, deserve it. The the real answer is read the fine print and buyer beware!

Doctors don’t have the final say. Facilities will always find a way to get rid of a patient and some of you should know that by now since it’s allegedly happened to your LO multiple times 😉

My experience with assisted living has been very negative especial in NY. My wife got the virus in a very upscale assisted living facility on in Long Island which now advertises on radio . It was not their fault it was the governor which I blame when he sent in positve patients with covid 19 from hospitals into nursing home in effect exposing the poor seniors like my wife over 6'000 patients died, the most upsetting thing he had javiate center, navy medical ship but did not use them and they had no PPE and very little staff.
Please don't do what I did keep her in you home your let her leave only until these nursing home can prove they are keeping their facilities in compliance with the federal guide lines. Which wright now is very questionable.
dealing with her facilities before she got the virus was almost impossible and to this day it has not really changed

It is the "doctor's decision" what level of care a resident needs.

I just witnessed a similar scenario. Nursing Facility Administrator was suggesting a "higher level of care" for a resident. The doctor stated "he disagreed."

The doctor had the final say.

Dont move her.
Even her Dr says she's fine where she is.

They probably just need her apartment for someone else and have beds available in the Dementia Care Unit.

Stand your ground and they can't make you move or yell them you will take them to Court and win because they told you she could stay there along as she lived and her Dr says she is fine

My mother was moved to memory care last month after almost 3 years in AL - same campus. She declined during COVID and I had not seen her since March. She was frequently trying to leave and they were mostly concerned for her safety, calling the police, etc. I really didn't want her to move, mostly because of the cost (close to $10k monthly, up from around $6k) and her leaving the staff, residents and all she had known for several years. Honestly though, it has been the best move. She doesn't really know she moved and was able to take most of her stuff. I no longer am getting calls that she is misbehaving, and she is being kept busy with the increase in staff and better trained. They also were able to adjust her medication and have a geriatrician that comes frequently. I have been able to visit briefly a few times recently and she seems more calm and peaceful. Good luck - not much advice but you are not alone.

Imho, your being "assured that she could remain in the [assisted living] apartment until the end of her life" was a rather BOLD statement. Certainly the relative with "mild cognitive impairment" may worsen. Prayers sent.

Hello. Having a LO in Assisted Living can be a challenge. Even when the place has the best of reputations, staff and living spaces. Mom was in Assisted Living for nearly 8 years. She complained frequently and I finally learned to say "No". But for the most part she would say she was happy. What I found as the Dementia and Memory problems increased, she was loosing the ability to be even slightly independent. She mostly wants attention. I guess I was really lucky when I found the place she was moved into.

They treated her like a "queen" and loved her as much as her family did. She was also fortunate enough to maintain a sense of humor. Why this happened is a good question -- All I can say is she reacted differently to me than she did the caretakers at the AL. I found it interesting that they could say to her "It is not nice to talk to your daughter that way", - and she would stop and then say she was sorry to me. They would know when she wasn't feeling good because her sense of humor would stop.

I know it is difficult, but I found that getting to know the caregivers on a personal basis helped both Mother and Myself. I Do now understand however, why they would want to move your LO with the explanation you have. When Mom first moved in they told me that she would have to be moved to MC only if she was to become a danger to herself or others. That never happened. Is there something going on with your LO that you have not been made aware of? Talk to the facility in detail. Get more answers. Good luck, this is never easy!

I am truly mixed about this. I just spent four months day to-day 24 seven with my mother who I thought was moderately impaired with dementia… Turns out she is severely impaired and gets worse by the day/week. There is also some thing called “show timing”. Look it up ...people with dementia who know they have dementia even severe dementia can light it up for whoever is currently around them even for an hour or more and they’re pretty good at disguising how cognitively impaired they are. This of course is exhausting and cannot be kept up for any length or period of time. Yes dementia is progressive and only gets worse over time; it never gets better. When it takes more than one aid to help someone who is constantly getting lost going back to the room they are so familiar with and even when outside occasionally forgets where they are or what they doing is too much for assisted-living sad to say. She probably is in need of a memory care and yes, by the way it is more expensive! I’m sure that a lot of facilities are motivated by money, but I can tell you that especially during COVID-19 when aids are probably fewer than normal, there are just too many patients and not enough caregivers available in assisted-living!

The first thing that strikes me is the comment about your mother walking the halls. Has exercise always been an important part of her life? I ask this because it sounds like your mother is at high risk for elopement, a technical term used in the care industry. It means wandering outside of the care home unsupervised. People with memory loss are kept in locked facilities for their own safety. I was horrified when I first learned of the key pads and locked doors, but soon came to understand the necessity. Elopement has led to the death of more than one resident. At a home in Colorado back in the late 90s, a woman in an assisted living care home walked to a neighboring market. She took a short-cut through an alley, slipped and fell on the ice and banged her head. The facility did not know she had left as AL residents are not required to check-in or check-out. She was discovered two hour later frozen to death. A person with memory loss can easily wander out of care home without secured doors. That person will immediately become disoriented because they will most likely not recognize where they are. We regularly hear in the news about missing people with memory loss.

Being able to dress and feed oneself are not determining factors for the move to memory care. Many people with moderate levels of dementia are able to feed and dress themselves. My Mom used to wear scarves everyday and dress herself in an elegant manner, but she could not follow a recipe or remember why she left the kitchen. She knew exactly which eating utensil to use if the Queen of England came to visit, but she could not remember my friends who had visited many, many times. Your best bet, as many previous commenters posted, is to meet with the facility and ask for specifics. All facilities are expected to keep a care plan for your mother, so ask to see the comments in the plan. You have a right to the plan.

I would also discuss with the community bringing your mother's furniture to MC. That is unusual that they do not allow her own furnishings and bed. MC is not a medical model, so there should be no requirement for a hospital bed. Do not place any valuables in her room (misplacement and theft) and, to make her comfortable quickly, bring along items she knows, like her bedspread, photo albums, artwork, furniture, memory box and anything management recommends.

Carefully review the terms for termination of the contract. Consult a lawyer. If the facility determines your mother needs to be in MC and you refuse, that could be cause for termination. When senior care communities promise to keep a resident for the rest of their life, do not believe it. Period. There are many factors than cause the relocation of a senior, including behavior problems (sometimes caused by poor management), health changes, memory loss, ability to pay, etc. Know your rights and responsibilities so you can give your mother a good life and have more effective communication with the operators of the community.

The vast majority of operators have your mother's best interest at heart. If they think she needs to move to memory care, then listen to the reasons and examples they give. You mother will have a higher quality of care with greater staff accessibility. The fact that the AL rooms are in such high demand speaks well for the community.

I have a girlfriend like you. She couldn't believe her husband was as bad off as he was. She fought every downward step he took. Like you, she would argue with the professionals. Just remember you are looking at her with the eyes of love, they are seeing the real her and where she is. She is going to go downhill where she stays where is or not. You said she is still able to function. How do you know this since you haven't been able to see her since March? That is 7 months ago.

First of all, how do you KNOW for sure that your family member hasn't dramatically declined since you've seen her last?? Many of these residents HAVE indeed declined, thanks to the lock down restrictions with COVID19 and not being able to see loved ones in person for months on end.

Secondly, your family member has been dealing with cognitive decline for 'years' now, according to your post, and dementia is progressive. That said, it may indeed BE time for her to move to the Memory Care section. What you don't see is how she's dealing with a microwave and a refrigerator and getting herself to and from her apartment and and and. There are a TON of things these AL residents are expected to do independently, with no help, that after a while, become impossible for them TO do when dementia is present. We don't get to witness that b/c we're not there 24/7.

Lastly, my own mother has lived in the same ALF since 2015; first in the regular AL section in her own apartment with a microwave, fridge, etc. She was diagnosed with dementia in 2016, but I knew she was going downhill for years before that diagnosis. She became more and more of a burden to the care givers as time went on, and on occasion, was a 2 person assist because of chronic vertigo. I knew they wanted her OUT of there for at least a year before she got sick with pneumonia and was hospitalized, then moved to rehab for 20 days. When it was time to go back to her apt at the ALF, the nurse came to the rehab to do an assessment and said No, you no longer qualify for your apt in AL, but we can take you in the Memory Care building. So that's what we did; we moved her out of her apt and into Memory Care which is a shrunken environment where she can function a whole lot better b/c there's less to deal with.

My choices at that juncture were........either move her into Memory Care or find another ALF that would be willing to accept her WITH a 4 year old dementia diagnosis and several health issues on her plate. There may have been an ALF that WOULD have taken her, certainly. I know that Morningstar Assisted Living does accept residents who are turned down by other ALFs for having too many issues, and they will charge nursing home rates to house them. That's the trade off.

You can always look for another ALF to accept your loved one, or, you can accept that it's time she's housed in the Memory Care section of her facility. You can also get her doctor to come in and give you his or her professional opinion of where your loved one would be best off living.

It's a catch-22, in reality. My mother says she 'doesn't belong' in the Memory Care, that there's nothing wrong with her at ALL and it's the others who are all 'stupid morons' and 'crazy' and yada yada. Meanwhile, she is lost in time and space and has no idea WHAT'S going on, even with an Alzheimer's clock to TELL her what day and time it is. Denial is very common for patients AND family members when dementia is involved. We tend to see them as 'much better' than they really ARE, and they tend to see themselves in the same light. When I worked at a MC ALF before the plague hit, we had one lady who insisted she was only staying there as a 'hotel' b/c she was perfectly fine (similar to my mother) and her daughter agreed. That hotel, however, was costing her $6500 a month. And I listened to her repeat the exact same stories 200x per day, day in and day out for a solid 7 months.

Sometimes, you can't win; they're not going to be happy EITHER way. But the bottom line is, the AL decides where your loved one belongs and they get to make that decision. If you disagree with it, you get to move her to a different place if you can find one to accept her. And then, if/when she declines a bit further, you'll be faced with the SAME decision all over again. If you do move her, be sure to find an ALF that DOES have a Memory Care wing.

Best of luck! I know how dreadful this whole thing really is.

i know you want her to have her nice apartment and everything she’s had thus far,...... when you place a loved one there however since they’re the ones who observe her 24/7 the reality is they naturally have a better grasp and understanding of where she is now, at that age things can change quickly so while she may have been ok to be in an apartment previously they’ve informed you there’s been some changes w her that in their best judgment make necessary a change. It’s a change and most of us don’t like change, she won’t have things exactly as she did before but there’s a reason they believe she needs memory care. Since they’re with her 24/7 they have a much broader understanding of where she’s at. Is your main concern that you really want her to be in a nice fancy apartment? ( there’s nothing wrong w that but I’m trying to make sure I understand is the change they feel necessary upsetting to you bc you want her to have the apartment and all her things she can have there - as opposed to the memory unit where she won’t be able to have the same environment? I’m assuming it’s not that you feel the care is subpar on that unit, but more a matter or wanting her to maintain her current amenities and apartment?

Do NOT move her! It is horrible that they would do this to her. So often the people in these facilities are LAZY and do not want to take the time to actually help the people in their care. If the main problem is communication then they could look at alternate ways to communicate. If she is having problems speaking you can even get her an iPad or device that has a keyboard where she can type a message and a button to speak. Dynavox has devices also with pictures if they can not type the words to show what they need. IT IS NOT IN HER BEST INTEREST TO MOVE HER! I do NOT trust their motives. She would become depressed and more confused taking away the things she loves! No, do NOT do this to her.

Did the AL give you actual reasons and examples of incidents happening as reason for why they want to move her to the dementia care part of the facility? They have to document any and all incidents or changes for all their residents. Demand to see every article and record for your relative. Do you have any official paperwork outlining what the criteria is for a person to be in the assisted living part of the facility? They always give you a packet explaining the level of independence a person must have to qualify for AL. I worked in an assisted living. It is different from a nursing home. Their criteria for the residents was that they had to be able to walk independently (using a walker and cane was fine), they could not be diaper dependent, and they had to be able to do basic ADL's on their own like getting dressed, going to the bathroom, and coming to the dining room for meals. If a resident couldn't manage these things independently they had to go. My place managed and administered their meds, prepared the meals, did their laundry, and assisted with bathing a couple times a week if a resident needed the help. That was it. AL is different than a nursing home. Make the administration of the place your relative is in, show you in writing what their criteria is for a resident in their AL area of the facility, and then make them explain to you in what ways your relative no longer meets this criteria. Don't take no for an answer either. From what you're saying it sounds to me like they want her up in dementia care for one reason: $$$$$ they charge more for that. Your relative sounds like she still has enough independence not to be in need of all that much hands-on care. A resident like her is easy-peasy for them up in dementia care. She's bringing in the big bucks but doesn't require all that much care. Don't let them get away with this.

We felt the same way about our family member.  We started with someone coming into her home to help her and spend time with her.  That caregiver told us she needed more care, so we shopped for an assisted living facility and also looked at locked dementia facilities.  At that time we felt she wasn't "as bad" as the folks we saw in the locked facilities so we chose assisted living.  We were wrong in our assumption as we had not spent day after day with her nor had we been with her for a 24 hr period...so we did not know how bad she really was.  We had to move her within 3 to 4 months out of the assisted living and into the locked down memory care facility because she wandered out the door and into the parking lot and didn't know where she was..  My point to this story is that visually she may seem fine or the same to you, but she may have worsened and you just don't realize it since you have not visited during covid or spent extended periods of time with her.

I truly don't see how the facility could have promised you that she could stay there for the rest of her life when she has dementia which we all know worsens.
Even without dementia, she could worsen physically and need more care.

Those pretty little things you've brought to her apartment are probably more important to you than to her.  I guess my advice would be to ask the facility what has changed that makes them feel she needs more care.

Good Luck.

Had the exact same issue. They moved my MIL from assisted to dementia unit against our will. She was obviously the 'sanest' person in dementia. It was heartbreaking to see. We found another facility within a couple of weeks that could and would handle her needs. The old facility tried to hold money that was due back to us. One lawyer letter later they refunded out money.

I wholeheartedly agree with rovana.

A social worker referred me to this forum and I have found it helpful. I wanted to experience an in person support group so I searched and I found one that was held at an assisted living facility. This facility only had independent living and assisted living. It did not have memory care.

We would meet once a month and two of the women that attended our meetings lived at the facility.

Their husbands used to live there as well but they were asked to leave because as their health worsened, their care level went beyond what the assisted living could offer. Their wives placed them into nursing homes.

The assisted living facility told the wives that they do everything possible to keep a person as a resident but it isn’t always possible to do so.

So I wouldn’t take a promise that was made from any facility as being true. Who can predict the future like that? People’s health can go downhill and they don’t have any other choice but to change their plan. It’s sad.

Ask the administration to outline the reasons they feel your mother needs to move to the dementia care unit. Compare their list with their qualifications for assisted living. That should help you make your decision.